have today relative to

that nih and others have to listen to it, and how do you see us raising this issue to the level of breast cancer when one out of every six families in the united states is affected by this, and i am just wondering. speak to be honest with you congressman i know a lot of it is the fact that we haven't taken the ability to really move, get out there-- ended my 15 years of working with men, it is very difficult for them to make a difference. i have explained to them, i have been out there fighting this for 15 years. sometimes it is difficult to implement that we really need to bring it to the forefront in part of the problem with prostate prostate cancers we don't work directly with what the

researchers, where the press coalition cancers do. we are lacking in a lot of areas and i hate to say sometimes it is he does. it is whatever but the bottom line is, as a woman, you bring the passion to the disease and you say, explaining to them and that is why a lot of prostate survivors have said to me and other women that they feel we are the ones that are going to make it happen and that is why we started the women against prostate cancer because we thought we as women, women that have lost their husbands or survivors or whatever are planning to come down to the hill, talk to congress and tell them the importance of losing our husbands or the possibility of that happening. they are just so many issues of prostate cancer that goes beyond just what we are talking about here that affects the family that again, as mr. farrington has said the education is so important. we just don't have the education like we need to. this is one thing i felt i really wanted to hone in on,

letting people know about what prostate cancer is, where they can go with their prostate cancer. you don't have to have it taken out because the first thing men want to do is get rid of it and that is not always the best thing to do for all people. i feel that really the education is really important and we need to help the congress to really be behind us and support the men sitting here who could have prostate cancer at one point. it is you that myself as a woman are advocating for justice these gentlemen here or any other man in my life. i am here because they care. i am here because my husband died of prostate cancer. i don't have prostate cancer but it has been very upsetting to me to know that you could lose a man over this disease and when it goes to the bones like you did with dean it is the most horribly excruciating pain that i cannot explain to you. he was working in congress when they have the pain and he had a

-- from the hip replacement. he would walk to the capital in excruciating pain and there was nothing we could do to make it better for him. that is a concern we have that we want to make sure we don't get to that point workout i just want to give you another note here. prostrate screening is not included in the provided health care reform and legislation in the problem we deal with would wipe out the prostate screening available to over 30 million men and 37 states so that is one thing i think when we go into the house, the bill needs to be looked at, that we don't overlook the prostate screening and the importance of doing that like mr. farrington said if you look at the numbers, it has been used as a tool. you have seen the death rate go down in the incident rate go up. even though more people are getting tight as there is not as many people dying from it. that is a good thing so again i think we need to get congress behind us to really be there, so we need to put our money into

outreach. we need to put more money into finding better tools to diagnose prostate cancer and just be able to do the best we can because i don't want to see men lost to this disease. >> thank you very much. >> thank you very much. my first question is to mr. goss it. first of all, when i was a teenager i was a big fan of yours, and one of the movies that i watched and still remember was iron eagle. whether or not you remember it. but it was one of my favorite movies during my teens. i represent the city of new orleans, which comprises of 60% african-americans. prostate cancer disproportionately affects african-american males. my question to you, knowing what you know now, what advice would

you give to my constituents as to one, how to prevent prostate cancer and two, what would they do if they were to have it, to fight prostate cancer, since you are a survivor. >> the way they have to be examined is a surefire way to-- [inaudible] >> i am sorry, can you turn on. >> the examination and certainly places like louisiana and detroit with the african-american man, it turns them off. you know what you have to do in order to examine the prostate. it literally makes them put it aside. they forget about it and as a result of more deaths happen

because people don't want to go through the experience. you know the experience i am talking about, with a rubber glove. that is exactly the reason why most african-american men did not go through that. they need to get that examination. they need to put it aside and go for it. i had a little bit of that because-- that it is over because i know how important it is. once you know you have it, then they talk about, and this is what i get in e-mails, a diaper, incontinence. that is the world that the african-american macho man does not want to let his mind, he puts it in the drawer and the next thing you know it is incurable. we need to educate them. we have to do deeper research to show it is more like a mammogram , to get them off that high horse. there is a fear of not being able to make love to your woman again and i'm speaking in real

terms. that is why the african-american man has more incidences of prostate cancer because he does not want to hear about it. he does not want to hear about not being able to make love, wearing diapers and having incontinence. those are real things especially for the poor. that is the last place he can express himself. he puts it in his back pocket until there is a problem. >> mr. farrington, do you believe we have done enough to inform the african-american community, the african-american male of the dangers of prostate cancer and the preventive measures in connection with prostate cancer? >> absolutely not. i don't think we have done enough to inform the high-risk community. >> what would you recommend? >> african-american men, men with a family history and some vietnam veterans, inform them

about the risk and you can prevention to death in knowledge. i am not sure there is a prevention to the disease itself but certainly the prevention of death is knowledge and early detection. what i would, because i learned in my testimony, i am a strong advocate of education. i've found are the prostate health education network and what we are doing is we are now reaching across the country through a number of means, to the public. we are outreaching through television, through on line and we have created a survival network of african-american men that can work on the ground in their community to talk with other men as mr. gosset pointed out. there is a fear about this disease but if prostate cancer survivor can touch another man and talk with him about his experiences and say i am here and i have survived in your hole

and you can do the same that you have got to begin the process of knowing your prostate. those are some of the things we are doing and in speaking with mr. gosset, we are starting this year a nationwide-- churches and we did that of massachusetts and in los angeles it just so happened the first book i wrote was unveiled in his church in los angeles, so we are going to work together. some of these things are a higher level of public education. >> be my last question to mrs. gallo, what would be your recommendation to women? how can they encourage their husbands to i guess to be more open to the procedure of prostate cancer detection? how can you encourage your

husband to take those preventative measures in order to stop suffering from this disease? >> nagging is always the first thing to do. sometimes it is making the doctor appointment for them and the other part is saying to them look honey, i want you around for a while and this is a deadly disease that is out there and we want to make sure you don't end up with that. i think women nowadays even the younger women are beginning, are really learning more about prostate cancer and need to get their husbands there. i know that there are a lot of women that have basically dragged their husbands to the doctor. some may be or a little more nice about it but that is why again we talk about education. my feeling is educating the women to go back and get their husbands, because most of the time the women are the ones who drive their husbands to the

doctor or are a little more persistent about it and also i say look, the women go through exams every year. look what we go through. yours is nothing compared to what we have to do. again, it is saving your life. i will give you a friend sent. at one point he said if it doesn't work, shoot me. when it came to prostate cancer in his possibility of dying that whole thing went out the window because the concert was he wanted to live. i think people have to understand that i don't think we have educated men and women enough to understand the importance of getting early detection and being able to treated at an earlier stage. 10 or 12 years ago or 15 years ago there wasn't much out there and i have seen such a difference in this 15 year time, that there are different ways to be able to help with the side effects and what not. what people have to understand, and if they don't tell them that they are more upset when they

find out afterwards because nobody talk to them. we can't just read around the bush and i'm talking about louis gosset talking about the side effects. we don't want to talk about it but it has to be talked about because when people find out-- that it creates another problem so i think it is more or less just getting women to really, if they care about their husbands they are going to get them there one way or another. >> thank you very much. >> thank you very much. we are going to, first of all thank you all very much for your testimony. we are going to turn for a half an hour to both send and this panelist dismissed. then we will come back and hear the second panel but your testimony has been very helpful. thank you very very much. >> mr. chairman? just unanimous consent, i would ask unanimous consent that my full statement be entered into

the record. >> without objection. >> thank you. >> thank you very much. [inaudible conversations 's be if you would stand, we swear all of our witnesses and. stand and raise your right hand. do you solemnly swear to tell the truth and nothing but the truth? if so, answer in the affirmative. thank you. let the record reflect all the witnesses answered in the affirmative. so why don't we just go right down the line and start with you and come right down the line. thank you all for being here. >> thank you mr. chairman for giving me the opportunity to speak and i also want to thank you for the accommodating of my

schedule. i am the clinical director of the national cancer institute. i'm particularly research focuses on the development of strategies for the treatment of prostate cancer. prostate cancer is a second highest cause of cancer deaths in the united states. the good news is the overall death rates from prostate cancer are on the decline. most think this improvement is due to a combination of improved treatments and possibly detection. however it is important to remember that there is not just one prostate cancer. some patients respond to treatment while other lives are cut short by the aggressive disease. the clinical course of the disease reflects the interplay between the biology of the tumor, genetics of the patient among factors in the environment and available treatments. their huge challenges in the field right now. we are struggling to differentiate lethal or deadly prostate cancer from nonlethal prostate cancer, a form to ever

cause symptoms early to death. another unfortunate reality is the burden of rustic cancer is disproportionately borne by african-american men who have the 60% higher incidence compared to white men and are twice as likely to die from the disease. many men will die with prostate cancer but not from prostate cancer. or never have cancer related symptoms. the potential for overtreatment is a real problem in this disease. nevertheless nearly 28,000 men die yearly from this disease while many others have cancer related pain. the single biggest challenge of research is to identify a means to distinguish legal from nonlethal prostate cancer. without this information we are likely to under traitor overtreated our patients.

even within these broad categories, prostate tumors may have very different characteristics which may ultimately guide treatment decisions. all prostate tumors are like other prostate tumors and they do not respond to therapy in the same way. inside the biology may turn out to be much more like a tumor that i prostate tumor. nci is moving aggressively toward the goal of distinguishing-- biomarkers, and genetic characterization, technology and techniques that may help to differentiate the aggressive prostate cancers from lesser than once. while the use of the antigen or psa has led to the early detection of prostate cancer in some patients with elevated psa values are found not to have prostate cancer and biopsies. furthermore there is no safety and people with psa values have a high risk of prostate cancer. we are searching for other biomarkers.

that would distinguish between cancer and benign conditions in between slowed growing cancers and fast-growing potentially lethal cancers. the identification of biomarkers is a high priority to provide saved screening. big clinical cancer team is that a new therapeutic approaches to prostate cancer through various clinical trials. for example eight prostate cancer vaccine has shown significant value and to move into larger clinical trials. nci is participating in research and development of a drug known as-- which targets blood vessel growth. results in a large clinical trial. [inaudible] we have continued to press forward in our effort to develop the knowledge to allow the prostate cancer based on

specific molecular characteristics of tumors that talk about the way the genes interact. in order for this to be successful we need to understand the relevant target of the tumor and develop drugs effective against this target. although this targeted approach is not successful for infectious disease for nearly a century unfortunately metastatic prostate cancer remains trial and error. that is drugs are not targeted or personalize for individual specific type of prostate cancer. we are aggressively pursuing research to enable personalized cancer therapies. we are optimistic that through the specific genetic abnormalities in a prostate tumor that we will not only be able to identify the aggressive form of the disease but also develop specific treatment appropriate for the patient's cancer ultimately reducing death thank you for the opportunity to testify. >> thank you very much dr. dahut. dr. brawley. >> thank you mr. chairman.

good afternoon. mr. chairman and distinguished members, i am otis brawley, a practicing oncologist. and the chief medical officer of the american cancer society and i am also a professor of hematology, oncology medicine and epidemiology at emory university. on behalf of the american cancer society and the millions of cancer patients and survivors, thank you for holding this hearing and for your continued leadership in the fight against cancer. as you know the society yesterday released updated guidelines on prostate screening. when new evidence or other information emerges. in the case of prostate cancer screening results in two randomized trials were reported early in 2009. the finding of the studies combined with other advances in knowledge related to prostate cancers grinning prompted this review. the review recommended no major changes in our position with respect to prostate cancer

screening. the society continues to recommend asymptomatic men who have at least a 10 year life expectancy should discuss with their doctor the uncertainties, the possible benefits and the known risks of screening for prostate cancer before deciding whether to be tested. there are uncertainties. there are non-proven risks and there are at this time possible benefits. we also provide additional guidance about testing for african-american men and those at high risk or go the bottom line is made me to have substantive discussions with their doctors in order to make meaningful decisions about which preventive services and early detection choice is the best choice for them. other organizations in the u.s., canada europe and australia that issue prostate cancer screening guidelines have also issued statements calling for this informed shared decision-making,

realizing that prostate cancer screening is not yet proven to save lives. i want to make sure my testimony is very clear about the society's position on prostate cancer screening as it has sometimes been misunderstood or mischaracterize. the society is not against testing for early prostate cancer detection of a man has been given the true facts about what we know and what we don't know about the uncertainties of rustic cancer screening. what we do know about the proven harms and the benefits and the possible benefits of screening. the society, along with many other health organizations as well, are against screening when the doctor-patient conversation is-- ascribes the benefit, to describe the benefits and harms does not take place in a meaningful way. where only gets prostate cancer screening when there is no informed decision-making. as an oncologist i have counseled and treated hundreds

of prostate cancer patients in my career. i've observed first-hand the dramatic impact this disease has on men and their families. i firmly understand the emotion involved when someone says they are life has been saved by a psa test, but in their friends since we need to better explain the limitations of the test and make sure we don't overstate the benefits. there is a legitimate argument based on scientific evidence as to whether prostate cancer screening saves lives. clear evidence has emerged from several trials indicating prostate cancer screening leads to unnecessary treatment or go for example, many men who do not have prostate cancer will screen positive and require unnecessary biopsy for diagnosis. in addition even if this biopsy finds cancer, prostate cancers grow so slowly that they may not pose a threat to the patient's life for his continued quality of life. this is an important point because treatment of prostate

cancers associated with side effects that can interfere significantly with quality of life such as and incontinence. the key problem is that we don't have, and we have yet to discover, definitive tests that tell us the cancers that kill and require treatment versus the cancers that don't kill and need to be watched. one can reasonably ask how do we get into this quandary of not knowing whether prostate cancer screening saves lives? the truth is the promotion of the psa test has delayed our medical progress because we have come to rely on what is really an imperfect test instead of doing the clinical trials to evaluate psa and actually defining the scientific questions and actually going out and answering those scientific questions. the plain fact is the psa test is not good enough. we need to invest in something and develop something that is better. we also need to invest in a way to determine the deadly tumors versus the tumors which are not

threatening life. in closing, increase funding for nih and the national cancer institute would do much to enhance current discovery efforts and also enable us to design better tests and better treatments for prostate cancer. thank you sir. >> thank you very much dr. brawley. >> chairman towns and distinguished members of the committee, thank you for this opportunity to convey the important efforts being supported by congress through the department of prostate cancer research program also known as the pcr p.. my name is dr. carolyn test and i'm currently program manager for the pcr p.. which has received over $1 billion in funding since beginning of the program in fiscal year 1997. here with me today as captain lissa king, my supervisor and director of the congressionally directed medical research

program under which the pcr p. is one of the largest of 19 programs. the pcr p. is the second largest nationwide funder of prostate cancer research after the nih. the program division is nothing less than to conquer prostate cancer. which translates into her mission to fund research that will eliminate deaths and suffering from this disease. we fund highly innovative science to stimulate advances in research and clinical care. all pcr p. funds are openly competitive with contracts of leading prostate cancer scientists, clinicians and survivors of the highest scientific merit and best that the objectives of the program. with a $1 billion in funding this program has received, it has provided 2200 grants that support cancer research in almost every state and the district of columbia. our grantees are studying better

prevention, diagnosis, treatment and treatment decision-making, identifying aggressive disease and discovering the underlying environmental and genetic factors that contribute to prostate cancer. our grantees are striving to answer the most critical questions in prostate cancer research and clinical care what several of these witnesses have brought up today. does prostate cancer screening lead to more harm than good and eschew how can this be corrected? which men with prostate cancer need to be treated and which do not? how can we develop more effective treatments for preventing or hearing the advanced forms of the disease that are responsible for prostate cancer deaths? to briefly highlights two of our grants, since fiscal year 2005 the pcr p. together with prostate cancer foundation has supported a prostate cancer clinical trial consortium which is brought together 13 major cancer centers across the nation to conduct faster, more precise and more cost-effective clinical

teaching and treatment. another four years the consortium has conducted more than 60 early phase studies investigating over 30 drugs and has moved five potential therapies into the final phases of testing before the new drugs can be approved. another key research effort is the prostate cancer project or pcap. pcap is a collaboration among institutions and louisiana north carolina and new york that seeks to identify the factors that contribute to the highly disproportionate impact prostate cancer on african-american men as others have noted who are more than twice as likely to suffer and die from prostate cancer than caucasian men. over 2000 have participated in the landmark study which make finally help us understand and address the factors that cause health disparity. the effectiveness of the pcr p. relies on a strong partnership between the u.s. government and prostate cancer survivors, scientists and clinicians. these groups were closely together to determine the program priorities at tapping

them every year to ensure that we are continually addressing the most important needs. for example, for fiscal year 2010 the program is focused on two major challenges. first, to develop effective treatment for dan's prostate cancer so fewer men will be lost from there families and society due to this disease and secondly to distinguish legal from nonlethal disease so a great deal fewer been diagnosed with prostate cancer will undergo treatment that is actually unnecessary that causes them intense personal suffering and has an immense financial impact on our health care system. to conclude, the pcr p. provides direct and undiluted support for prostate cancer research funding innovative projects and researchers that might not otherwise be supported in the battle against this disease. i thank you once again for your interest in hearing about this program and we look forward to any questions. >> thank you very much dr. best.

dr. kaminsky. >> chairman towns thank you for the opportunity to address you. the uniformed services university, your university and i'm here to talk about one of the programs that congress set up at the university, the center for prostate disease research and it was the inside of congress that actually put this program on the map within the military, and i think the thing that is most important about what it put on the map is the fact that within the military health care system we have access to health care. with this particular center which is set up in three different aspects, the critical research center, a basic science research center in the database and repository the center is actually made enormous inroads into understanding the disease and equal access medical care system. the center was the first to

actually demonstrate that african-american males in the system actually needed to be screened earlier and more often with the testing that is available today. the challenge for the center is everything that doctor brawley talked about and that is how do we really come up with better screening tools. that is really what the center is all about from the standpoint of trying to really look at the aggressive forms of the disease and how to actually get there quicker, faster, better. today we are working on new genetic tools to try to do that and actually have some products that are hopefully going to be, make transitions. but one of the key pieces of the center is actually the database which is following over 28,000 patients in a longitudinal study with over 102,000 tissue and blood samples so that we can

actually look at and analyzed the disease across time. so, to keep us flowing, i am going to hold my comments and hopefully questions at at the end about this particular center and about essentially congress's wisdom in setting up a center like this at the university within the military treatment facilities which allow us to do things that maybe others can't because of the kind of help their system the military has. again thanks for the opportunity to talk. >> thank you very much dr. kaminsky. dr. shtern. is that correct? >> chairman towns, thank you for the opportunity to testify today and for your continued support of the foundation. there are many members of this committee who are supporting our work. as you know there is no family, no community in this country

that is not impacted by prostate cancer. when my father's prostate cancer was-- leading national hospital, a very powerful.was brought home. in spite of the-- of prostate cancer epidemic, men do not have accurate diagnostics for early detection which is critical to cure cancer and to save lives. the new guidelines by the american cancer society, there is no diagnostic tools for screening and early detection and american men die every 90 minutes because even though prostate cancer can be cured when diagnosed early. echoed sentiments.

prostate cancer and its treatment lead to anger and confusion among the men who have it and those who love them. mr. jennings, age 49, was diagnosed with aggressive prostate cancer only recently. he underwent surgery and hormonal treatments and medical. according to a recent study, men aged 50 and younger have had seven fold increase in the incidence of prostate cancer since 1986 when it was invented. my father's story is a genuine story that reflects our prostate cancer crisis. many other speakers pointed out the first aspect of the prostate

cancer crisis, the sheer multitude. many more millions face the threat of prostate cancer each year. african-american men have pointed out repeatedly are disproportionately affected unfortunately for millions of men. there is another aspect of prostate cancer crisis. current diagnostic tools are unreliable and has been pointed out to a staggering extent unnecessary biopsy, unnecessary treatment and failed patient care. this reduces the quality of life in men and billions of dollars in health care costs. in my written testimony, my estimate is over 5 billion each year wasted and health care

costs. our core mission is to end our prostate cancer-- accurate imaging tools for early detection and treatment. i would like to issue a disclaimer. imaging will not-- screening prevention but imaging will be critical for early detection and minimally invasive treatment and here is why. on the left of the slide you can see digital mammography in 1991 when i was the head of diagnostic imaging at the national cancer institute or go at that time you are likely to see a larger cancer. on the right you can see digital mammography done today. there is a striking difference in the quality.

you can see a tiny breast cancer. precise imaging has made it possible to guide needle biopsies to detect breast cancer very early and to save lives. just as importantly, to replace -- with imaging guidance, minimally invasive lumpectomy's are more common in breast cancer. men do not have accurate imaging. this congressional support and federal investment can create similar opportunities for men. on the left you see data from new york. it shows advanced prostate cancer missed in every imaginable diagnostic including

blind biopsy. there are reports from all over the world the show mri guided biopsies can detect at least 60% of prostate cancers that were missed by the blind biopsies at least twice. there are growing reports i am happy to report that imaging technologies molecular imaging mri can determine what is aggressive and what needs to be treated and what is nonlethal they cannot be treated. this report creates great hope for the future of prostate cancer care and is extremely preliminary for the expense of research needed. on the right-hand side you see a three-dimensional mri. it shows early prostate cancer. when we have this kind of three-dimensional data, we can see that image guided minimally

invasive treatment to eradicate cancer while saving normal tissue to avoid complication. these procedures can be performed in outpatient screening with minimal cost, complication and discomfort to the patient. that is how we end of prostate cancer crisis, with advance imaging. in order to save lives, improve quality of life and save billions of dollars. i was just told that the representative-- just introduced h.r. 4766 that calls for national investment of 500 million dollars over five years in medical imaging. it is only 10% of the annual waste in health care costs.

this also calls for increased $100 million for improved diagnostics over five years. it is only 2% of the annual waste. the success at the end of the five years, we will have accurate imaging technology for improved early detection and treatment and reliable in vitro testing for screening and prevention. i hope this committee will empower and support nih in making research diagnostics including imaging and much higher priority than it has been. [inaudible] it will be an important step in that action. thank you or your leadership.

>> thank you so much for your testimony. dr. mohler. >> my name is jim mueller and i in the chair of the department of urology at roswell park cancer institute in buffalo, new york. boswell park discovered psa that has been taking it eating here today. also, i chair the national comprehensive cancer network, commonly called nccn prostate cancer treatment panel. the nccn consists of 21 of the 40 nci designated comprehensive cancer centers. finally, i am the principle investigator for pcap, the north carolina louisiana cancer project that are best mentioned earlier which is the largest population-based study of prostate cancer ever undertaken and half of our patients in the study are african-american.

i would like to discuss just four points that warrant our attention and then make three recommendations. the first is that, prior to the development of psa, only 4% of men diagnosed with prostate cancer could be cured. most men were diagnosed with prostate cancer by congressman gallo, when it has spread to their bones and has caused pain. the standard treatment was androgen deprivation therapy and that survival was three years. now less than 10% of men are diagnosed with incurable prostate cancer and five-year survival. treatment is essentially 100%. however the age adjusted incidence of prostate cancer has increased 30% since 1994 to produce this 36% reduction in deaths. if we had achieved a 36% reduction in mortality in any

other solid cancer in america there would be cause for jubilation. so why is there so much controversy about psa? that controversy stems from my second , and that is a term that has been discussed here, autopsy prostate cancer, also called nonlethal prostate cancer earlier. the problem is that the incidence of prostate cancer is approximately the age of the man in other words, 20% of 20-year-olds already have prostate cancer in their prostate and 80% of 80-year-olds already have prostate cancer. prostate via seas will find about half of these autopsy cancers. because psa has been mentioned here today can be elevated for many reasons, many and may undergo prostate biopsy and have a non-toxic type of prostate cancer found.

this cancer poses no threat to their life expectancy. the "new england journal of medicine" published back-to-back papers in their march 26, 2009 issue that is reignited this controversy about early detection of prostate cancer, which has been increased by the acs guideline change issued yesterday. the american study shows no apparent benefit from psa early detection although many men were ineligible for the study because they probably had already have their potentially fatal prostate cancer is diagnosed and treated in the majority of the men in the army-- that were not subjected to screening received psa's anyway from their personal physicians. finally the follow-up of the study is so short that any benefit from psa early detection would not yet be apparent. the european study shows the benefits of early detection

using psa which is actually surprising to me because it's follow-up also a short. the psa screening frequency was only once every four years. the press has focused upon the fact that 1400 men needed to be screened and 49 men needed to be treated in order to prevent one death from prostate cancer in a european study. over treatment of prostate cancer would not be an issue of the treatment had no side effects and was free. this brings me to .3, over treatment of prostate cancer. the nccn guidelines have responded by changing their guidelines last month to focus on more careful depiction of aggressive prostate cancer in younger men while urging a more conservative approach to early detection of prostate cancer in older men. the nccn 2010 guidelines also recommend active surveillance of men who have been found to have low-risk prostate cancer when

life expectancy is less than 10 years. in addition the nccn has created a new prostate cancer risk category, very low-risk prostate cancer. active surveillance is the only recommended treatment in this group of men when life expectancy is less than 20 years. let me emphasize that here is a cancer treatment guideline panel recommending active surveillance instead of treatment. these changes allow appropriate aggressive treatment of men who are at high risk of death from prostate cancer while avoiding over treatment of men at low risk of prostate cancer death. my last point is, how psa and treatment can actually perform better than it does today. african-american men and men with a family history of prostate cancer especially in their brother or father represented group of men that we all agree are at higher risk of death from prostate cancer. psa and treatment will perform better if efforts in early

distinction of prostate cancer are focused on these higher risk groups. this leads me to my three recommendations. the first hasn't been made by anyone yet. we needed blood or test that can be combined with psa to indicate who doesn't need a biopsy. this is critically important because then men with autopsy type of prostate cancer can be spared biopsy and the anxiety attached to the diagnosis of an autopsy prostate cancer. i agree with the other panels that once diagnosed with prostate cancer and tissue is available, we need better imaging, or a tissue-based biomarker of-- currently psa correlates with prostate cancer with groups of men but not individual patient's. more funds must be spent to develop biomarkers of aggressive prostate cancer and i believe that these markers may come through more careful study of

the prostate cancers found in african-americans. until we succeed in these two areas, the nccn guidelines should be used to guide the diagnosis and treatment of prostate cancer to assure that we continue to reduce the mortality from prostate cancer while not subjecting men to the consequences of over treatment. a tank of the committee for their wisdom in addressing these very complex issues posed by prostate cancer. >> thank you very much and let me thank you all for your testimony. the way i want to start out, i generally ask the witnesses, are there any statements that you have heard that you would like to sort of clarify, give your input to them either from the first panel or from this panel. the reason i do that is because i was at the airport one day in the person said to me, i did not agree with anything that person

said and you didn't allow me to respond. so i don't want to be guilty of not allowing you to respond. dr. brawley. >> if i may, sir. in the first panel i heard the mortality has gone down so it must be because of screening. i think it is important to realize that if you go to various countries in europe which have had the policy not to adopt screening, mortality has been going down in those countries as well so it is hard for me to attribute all of the decline in mortality in the united states to screening and there are several other countries, britain, france and so forth that have a decline in mortality without having screening. secondly, dr. mohler talk about, my good friend dr. mohler by the way. we worked together on a number of things, talk about five-year survival. when i'm teaching epidemiology and teaching screening, we don't use five-year survival is a good

use of outcome. it is not an evaluation about, especially in prostate cancer where many of the people with screening would have never died if they had those autopsies. they actually artificially pushed the five-year survival rate up. this is best seen in the old studies of lung cancer. lung cancer screening with chest x-ray. by the way we have been here before. lung cancer screening was advocated in the united states from 1960 to about 1975. the otis brawley's of 1960 did a study. many people said no. it increases five-year survival rate. when those studies were done my favorite is the mayo clinic study. the death rate on the screened arm of the mayo clinic randomized chest x-ray study was 3.2 per thousand per year on the screen and 2.8 per thousand per

year on the unscreened. keep in mind, survival was increased on the screened arm but risk of death was increased as well. so, when we teach epidemiology and we are doing screening we don't look at five-year survival rates. we look at decrease in mortality rates. that is what we want to find. >> thank you very much. anyone else? guest dr. mohler. >> i cannot let the statements by otis go under it-- on address. >> are you guys really friends? [laughter] >> i always like to say that two people can be looking at a horse and if one is standing at the head of the other standing at the tail they describe something that looks very different. many aspects of this debate are about where you are standing. the decrease in mortality in great britain which has been argued to counteract the 36%

decline in age-adjusted prostate cancer mortality in america has been thoroughly investigated. great read written change the way that their national registry recorded deaths at autopsy and when this was accounted for, the decline in prostate cancer mortality in great britain basically went away. i think our country is unique in having had objective evidence of declining prostate cancer mortality. this occurs at the same time the worldwide incidence of prostate cancer is increasing 1.1% per year. the reasons for this are unknown the best evidence suggests that this may be from westernization of the diet. but we do not know much more than we do know about prostate cancer, and so otis has very

appropriately challenge the five-year 100% survival teeing inadequate to study -- not to say the treatment is effective. we know that we follow these men longer, many of these will work her but this is the data reported to the american cancer society and why i can conform to the five-year number. >> thank you. there was a statement made at the previous panel that only 25% of women undergoing biopsies have breast cancer. what i would like to refocus, if you look at the number of breast cancer is close. let's say around 2000 per year. the average yield, the percentage of men who have cancer and are undergoing-- according to the data is 12%.

so if we look at that we know from actual numbers that 1 million men or 1 million humans undergo biopsy every year. however 2 million men undergo biopsy every year. these are the imaging tools that will eliminate-- and will eliminate freelance biopsies then. there is the possibility to save over $2 billion. >> thank you very much. we will go to you dr. brawley. i understand of course you are perhaps an expert on cancer screening and i respect that and really appreciate that you were here and your work over the years. before i get to that focus i wanted to ask your opinion.

any correlation between education and diet and why african-americans are significantly more disproportionately impacted by the lethal form of prostate cancer. i lost a brother to it. >> yes sir. thank you. we have been working long and hard for probably now 30 years to try to start addressing the question, why do blacks have a higher rate around 1980 and by the way it is blacks in the western hemisphere for sure. blacks and resell rozelle and jamaica have a higher rate as duplexing canada. don't know about blacks in africa because there is no good registry and the national cancer institute of the united states actually try to establish a registry to try to figure it out and just couldn't. what they-- data that we do have indicates a large number of the black prostate cancer problem can be due to diet. it can be due to differences in

diet over time, differences in rotting mass index. there are some studies that have been done primarily in animals that indicate that animals that are fed a high-fat diet when they are pregnant, their children will have a differing sensitivity in terms of and androgen tours when the children are born. so there are people who have speculated that it is so social economic status of the fetus and the mother and a the diet of the mother went in you that actually affects risk of both prostate and breast cancer 40, 50, 60 years after birth. for example many people talk about the breast cancer problem and blood women with triple negatives. if you go to scotland one of the best studies has been done in scotland where it they have no

blood women. they figured out women in scotland who have a lifelong history of poverty and you can't look at social economic status at the time of diagnosis. you have to look at social economic status over of the entire lifetime beginning in utero. women who are born and have a lifetime of poverty have cancers that are more likely to be triple negative, more likely to present at an earlier age just as black women in the united states so social economic status, diet and a number of other environmental factors actually can change the genetics of the breast cancer. reception negative as cancer, that is a genetic difference that white women in scotland who are poor tend to have more of that than white women in scotland who are not poor. >> dr. mohler. >> the north carolina louisiana prostate cancer study is seeking

to look at many of these dietary and lifestyle differences that may be contributing. i think it is very important to recognize that there is fundamental differences between the african-american prostate and the caucasian american prostate and dr. brawley is exactly correct, that we don't know where these come from. but, one of the fundamental questions that pcap will address is whether the african-american prostate seems to have a raft of androgen access. the circulating androgens are the same between the two races, but the african-american prostate for unknown reasons has more of the protein that testosterone binds to to turn on growth than does the caucasian american prostate. that level of protein is 21% higher in the benign prostate and once african-american men develop prostate cancer, the

cancers have 81% more of this protein. it is completely unclear why that is and whether this is a consequence of diet and lifestyle has something to do with genetics, environmental interaction, but much of pcap is devoted to figuring out whether this is actually true in a large number of men from a population-based series. i still think that most of the racial differences in prostate cancer mortality stem from social economic disadvantage and not race per se. in fact, when we look at our treatment results in north carolina and louisiana, once you correct for socioeconomic status, race is no longer a factor in treatment received or outcome of that treatment. >> you are also saying that education plays a part? >> i think that is the greatest contributor to the racial disparity, yes sir.

..

the. >> when we talk about prostate cancer or really talking about the flu that i use the term broadly vs. h1n1 of the prostate and some other group of various things we use a broad brush statement when it is in the prostate but not prostate cancer? >> what we are talking about is actually the prostrated self that becomes malignant and start growing. >> but there malignant due

to different forms of cancer that they reacted differently and differently treated and if you could isolate various strains and treat them are pretty you could have better results? >> that i would agree with but the cancer itself originates from cells in the prostate and there are a variety of different more aggressive in less aggressive in describing what it prostate cancer was using autopsy specimens and even the we have moved into a molecular age 160 years later we're still using the microscope definition of cancer that is why we desperately need molecular tests were i think is where it will come from mr. smith you have prostate cancer but it needs to be watched buy mr. jones you have prostate cancer read to treated aggressively because if we don't it will bother you.

>> the american cancer society has put out figures in both breast cancer and prostate cancer and they're relatively interesting in the sense of the similarity. breast cancer 192,370 cases of invasive breast cancer. in hundred 90,280 new cases of prostate cancer i noticed there is a word missing half the deaths today after all of the work from breast cancer 40,170 from prostate cancer 27,000. to understand the statistics and balance, if i understand correctly 192,000 prostate cases if you took out the bonds that were likely not to kill you in hindsight, you're probably not talking about 192,000 or

19,000 but 10,000 cases new cases and then use a way 22nd have a right end up with 27,000 deaths? a one to understand what that figure is. >> when the doctor talks about 30 or 50 people treated for one my saved those of who are screened and dejected. >> screen and found to have cancers fam i remember screaming will find the disease would not have found if there was no screaming pro a man in the united states to choose is to be screened doubles but chance to be found from one out of ted into one out of five. >> if you don't look you don't find. >> exactly. by the way come on the other hand if we take european steady to 20 percent

relative risk and increase of death, and that is 3% going down 2.4% by risk of death. the answer to your question is 30 or 50 /1 is of a screen population. >> but when you get at that are 192,000 for the two types of cancer and more people die of breast cancer, a cancer that we can look at with mammography and a better feel to be able to see it and feel it and eliminated but you have a higher number. to me that begs the question when we use the #1 hundred 92,003 basically saying here is a cancer we're not very good at curing but we're also not very good at putting a number up there that kills you? this is the number of people with live 20 more years?

>> yes. 192 vs 192 that says invasive breast cancer will kill the men and 192 prostate not so much. >> that's right. but if you will bear with me. >> i don't want to interrupt you excess of the bible like to know after the fact if you could we estimate the 192,000 to give me your best guess of invasive cancer so we can look at the cases bursts days versus the death because it makes it look like breast cancer is more likely to kill women but it looks like there is less cases but we don't do so good with prostate cancer senate that is the reason i like to look at a mortality rates than the absolute numbers. we have nine randomized trials of breast cancer that consistently show mammography screening decreases the mortality rate. two out of the nine have the

focus of women in their forties by the way. we have four random negative chiles a prostate cancer that have never been attempted one was not psa three at a four actually show a slight increase risk of mortality versus the yen screened are but one of the european segments show that the 26% increase in in mortality. we have three studies that say this screening could be like lung cancer screening in the '60s we have one study that says no. it does save lives. >> i will concentrate on two questions. the europeans rather the day lower mortality they spend less is that right? they basically decided whether because of the cost they did not see a benefit they decided to prescribe

less action both in testing and treatment? >> yes. govett relates directly to the health care debate going on right now. if you go out and do it i can name 12 things you mentioned the mastectomy earlier agreed did that for 75 years because the doctor said it was a good thing and we criticize all the people who wanted to do any violation for more than 75 years finally may get around to do the evaluation and we find out that lumpectomy with radiation is equal to the domestic to me we did the wrong cling 75 years. psa came out late 80's and restarted encouraging people to get it rather than doing the adequate evaluation the europeans decided to do the adequate vibration the

contamination rate on the european study is so low the number of them control who did not get it because you can i get the psa unless you are in the study. >> i realize the indulgence but very quickly because you are someone who is talking about the alternative to anybody who talks about where we should invest in research for alternatives including if you talk about the next generation psa that is not such a shotgun approach to diagnosing specific cases of invasive cancer? >> thank you very much. >> i would like to refers to a couple of numbers i think to be put into a slightly different perspective and slightly different statistics. that the frame prostate

cancer in spite of the numbers. if you look at the number of men who fail prostate cancer treatment every year it is 70,000 men. what this means in practical terms 50% of men the treatment fails sam prostie -- prostate cancer persist and becomes life-threatening. this is 70,000 men. if you look at another number if they said there was a steady over 76,000 men and they demonstrated the necessary treatment, a 54% of men have unnecessary treatment. that is why with the

procedures alone the could never get the hospitalization costs. the bottom line is essentially a under treatment bailing on the other hand, we have failed treatment and retail we do not have diagnostic information. or four indigene to have appropriate treatment that is why the investment is that critical. >> thank you, mr. chairman chairman and i think the day after you eulogized jack murtha of it shows we don't want procedures unless a yields the right result because it can they do of their loss of and quality of life. >> i yield to the gentlemen

of california the. >> dr. brawley dinky for being here. i would like to address that you argue that prostate screening came before adequate studies were conducting an the such studies are still needed. in the meantime, who should be screened and when should they be screened should black man first and then at one age than white men at to another? and how should screening be utilized in the treatment? >> you may have given answers before i came in. >> a very important question. of the most important thing is the truth because a lot

of what i am hearing by advertisements and other places sometimes from hospitals that make money sometimes from survivor groups that want to do the right to saying it they are frequently supported by industries that take the test. but frequently but not always. they need to know the right to information but they don't know if this test saves lives there are people who think that it does provide i think it does save lives but i know we have to treat a large number of people in order to save each life. some men may want to take the option of getting screened and we should support those men some men may want to not get screened and we should support and

not criticize those men for that decision. i really do believe we need to have informed decision making the american cancer society says they have done that since 1997 but people would read what we said then said the acs men says men should get screened they say men should be informed and make a decision. that is why we changed our guidelines. it is within the physician and patient relationship none of the freeze greening 10 to generate income. within the relationship the position and the patient should have a conversation to talk about the uncertainties and unknown risks and the possible benefits and make a decision to what is right for the patient part of that is what we need to be doing. >> years ago when it was in the senate in california i

also was very involved in a state wide organization with black women with breast cancer a few months ago the question, not the question women ought to wait later until they are 40 before they do the screening i am talking about breast cancer in this instance the women part of our study was directed at ucla under dr. love by the time when our two years past all of them were dead. i was struck that there is something in good dna among african-americans that causes cancer at an earlier age and i am recognizing that because i carried the bill for the first screening on prostate cancer among

black males. i think you might have answered this it may have to be individual but i do see african americans more prone to prostate and breast cancer than other groups what will we have to do and how much time will it take us to come up with some decisions? >> unfortunately we have lost a lot of time because we started to advocate screening in the early 90's in the towel we lose time is saying everybody should get screened to figure out a screening works and things like the steady just reported was five years late because of the slow accrual why would you go into the steady when all of these advertisements say screening saves lives? that is how we slowed down.

once we got people understanding this is a huge problem it will be 10 or 15 years before we can get a good answer and just like dr. mohler study and wonderful things a department of defense studies and it takes doctors to our practicing medicine to realize this is a problem the over diagnosis was put down by a number of positions in practice in the early 1990 90's with those of us who are seeing is a problem. know we have numerous studies the prostate prevention trials my favorite is the only steady to biopsy normal men been in the '60s over seven years could die ignite -- diagnose 13% and also shows that the psa mrs. just as many prostate cancer as unfounded

of the 26% of men in the '60s who were diagnosed only 3% 12 dae. three out of the 26. that is the indication of the over treatment there was actually a vote in the integration committee earlier in the decade that said more money for the defense department ought to go to seeing how to take the money away from the studies of the biologic behavior of the prostate cancer so we lead to our emotions i am very emotional because i want men to get the right thing and i know i am hearing that men are not getting the right information. >> the gentleman's time is expired i yield to mr. cummings a. >> thank you very much.

doctor, let me ask you this or any other panelist, the problem is i think lou gossett said it earlier when he was talking about african american men but he could apply it to them then point*. they are squeamish about the prostate and in the exam and and so i am trying to figure out they already are not likely to go and for the exam and don't want to talk about it so how do you make the jump with all of the new information that just came out yesterday to give men the excuse not to do it? men look for excuses not to do this. they'll ready don't want to do it but really not now if

they said see? they told do it did not do any good anyway so how do we deal with that? is seems the question becomes even if i go and and it sounds like there is confusion. do you follow me? >> what is the best argument to a man who is looking at you right now to go and try to address this issue? >> i can tell a the argument to address the issue but not why they shouldn't be screened baidu think there are guys like the experts who came together who said does not want to be screened we should support that decision. but i do think we should be talking about prostate cancer. what a big problem in the black community is a number of men have the difficulty

urinating and suffering from that and i do think we do need to talk about these things openly and i will tell you growing up and becoming a expert from the inner-city of the charge were all of my relatives were afraid people for not telling the truth found out my relatives for why is because on this issue there are a lot of things out there that is not truthful but to misleading we do not know of prostate cancer screening saves lives. some of us think it does but i hear routinely that prostate cancer screenings save lives and i hear routinely any man who does not get screened is a fool by yet i have nothing to do with the acs guideline i am a staff person these are volunteers comment doctors comment e epidemiologist in patients who met over a

period of one year looking at all of the literature that we have and they came up with the same thing this from 2001 there is huge uncertainties people need to know there are huge uncertainties to make a decision about what is right for them. >> dr. shtern the imaging that does it appear the imaging that dr. deweese testified earlier their radical party of prostate cancer then more like a dormant? i don't know if that is the right word is that the believe this imaging can detect which one it is? >> it would be possible to develop imaging tools to

differentiate but the current eve rigid information talks about specifically the university of california may help to differentiate from prostate cancer. in a few days in march 10 there be a study published in poland and he is presenting data in 51 men wear the imaging was able to discriminate that aggressive from nonaggressive cancer. there has been rather extensive research needed it and that is why investments

in imaging increase. thinks is a direct ic my time is up. >> i know i am running at a time. >> i want to reiterate negative i think you heard a message that to we need in addition a way to detect prostate cancer better way to celebrate autopsy from the legal prostate cancer that is the common theme. but the problem right now is men have to decide what to do now they cannot wait for dr. brawley 15 years steadies. what happens in the 15 years since the american a european screening studies were designed? medicine advance and then the results of 15 or 20 years into the future become obsolete? mentor faced with a difficult problem of what to do now and the guidelines

emphasize aggressive leave finding prostate cancer in young men because the and man you can detect prostate cancer he will live so long he will die. you need to relax as they get older because they will suffer the increasing incidents of the autopsy camps are you do not want to go aggressively find purpose of the treatment is justifiably criticized because there was overzealous use of psa for early detection and treatment we need more science to separate the autopsy cancer then we don't have to be having so many of these discussions. >> let me indicate we will leave the record open for five additional-- our comments or information and let me thank all of you for your testimony today.

it points out we still have a long way to go but we appreciate your work and what you are doing and working with you as you move forward. this is an important hearing if you look at the statistics and what is really going on. let me thank you again and this time the hearing is adjourned. [inaudible conversations]

and how to provide the subjects that are really about innovation. can arianna huffington at is our guests the first half of the session started morale very nicely by a choosing the road to ruin as her book-of-the-month which means that have to ask

questions during this interview session. i would take to invite you up on stage and she really doesn't need. [applause] she really doesn't say much of the introduction i think she has become in the media industry when a great disruptive innovators of our age it makes sense they wouldn't have any money in the future as a result without the brilliant insight this persuading people to write for nothing. [laughter] of but the subjects we have to broadly framed our conversations is is america a third world country? it is interesting thinking about that title almost by instinct probably better to be a third row country because there are a lot more

exciting things going on and so forth. [laughter] what lies behind your concerns of america becoming a third world country? >> it is great to be here and it is a great book. >> i did not say that. >> i definitely said that. [laughter] >> and in no way i am grasping some of the issues i am writing about whether america is becoming a third world country but if we look what is happening to the middle class with their foundation we have the american middle-class being squeezed to create a major danger not just for our economy but this is done something that just happened

because of the financial crisis but some of that has been going on for decades now i don't want to bore you with another steady but when you have one at a five americans out of work one ad of nine who might have been for closed-door default the one relying on food stamps who can to make the credit card payment did over 100,000 declaring bankruptcy every month. i know. >> i saw some statistics that show for the median american household was the century that the only source was increasing spending power with mortgage and equity with or without that there would be no increase

whatsoever of the average income in the household fed underlying point*. >> because america has been a country of upward mobility. of the americans win being within net of room while. if you have a country to it has been mentioned in the earlier session i expect your children to do worse than you in just about every indicator including life expectancy. and that changes the whole tone of the country. it saves america from being optimistic and with a big country and welcoming of foreigners to a country that suddenly has become a angry and we see these explosions of finger whether the two-party movement or the

explosions of congress over the weekend. this is unusual and when people are called the leader that way. they operate out of fear rather thin rationality. >> where do think the answers are with innovation? >> i think first of all, innovation is key because i don't see any of their way to have job growth will have a job growth based on consumption because people don't have the money to spend and those who had money to spend our saving more at the wrong moment.

the president is just signed into law a very exhausting $15 billion which will not make a big dent in dealing with unemployment as we were talking about before the session now has 50% unemployment. imagine what that means it? the decimation of an entire city so innovation is the only way to see job growth and it has to become of primary importance when it comes to government quality and for the private sector. there is a movement in england does the word discuss saying it that is if you own a direct bus but basically it talks about the

need to bring more humanitarianism and who will be speaking but are they really talking about the long game? but to be involved in something bigger than our own life to make our lives mature in some way? getting people who are also coming down in bond dissolutions but the many people in this room are doing that the combination of for-profit and not-for-profit my eight version prevents-- helps college students for innovating at the same time creating jobs and opportunities is really the futures. >> you have whole other technological development with social networking and

yet in many ways at the same time to the political process needs to be more fractured and capable of making the big decisions. will that resolves all? >> it is completely broken. at the moment it is so dominated by a regulators and when you have thousands of lobbyists descending on washington and many of them are former members of congress are chiefs of staff they know what to do in millions of dollars to spend and both political parties are dysfunctional the republican party more than the democratic because we became a party of faction rather than maternity.

citizens have a greater role to play then they would have had in the political system. we had them fall into move but suddenly it was spread everywhere as we call move for many. but fresher it with the fact that nobody would change with that too big to fail banks we thought what if this is a since made them smaller by moving deposits out? and in the process, basically made it possible that the community banks and credit unions who have more money in the communities then that creates jobs and in a cycle and can varying from it's a wonderful life with

mr. bailey. and about 9 percent of people have moved their money. it is spreading from the cities, states, people are wanting to be empowered and feeling increasingly frustrated by the lack of action with the financial reform beam and tim geithner speaking today. again there is a sense they're not talk gain too big to fail. and for it to work you have to allow companies and banks to fail and that is what i love about your book. systemic risk means the government erred taxpayer is on the hook for massive risk-taking. there is no way you can regulate against that

because look at how many regulators with aig or lehman brothers and it did not help anybody. >> i do think it is quite interesting if you look at the proposal there is no real attempt to wipe the slate clean and start again. there are so many regulations in america that talk about somebody else to be responsible for its 10 there is no proposal because fundamentally means they would not get campaign finance to oversee the regulators. the corruption seems to paralyze in the case of huge reform one of the things i talk about is how the media

failed to cover the financial markets and of the conflicts there coming in to promote its share in trading circles but immediately on cnbc for them to disclose the shares and with a list of all the money they receive? every time it is that kind of popular corruption but i wonder if it does not seem to be the anchor and a practical way directed as the fundamental corruption. >> first of all, i would love to see the innovation you are describing i think anybody here working on new tools you can produce that

kind of tools every time a politician speaks something would pop-up and tell you where the contribution was coming from than every time they would say something it would pop up and tell you whether it was the truth or not. [laughter] because another issue is a complete breakdown of trust. when you have sarah palin and senator chuck grassley over the summer come talk about death panels would and did actually read for everybody? it would be a completely non-partisan tool selwyn barack obama said over the summer he had not supported

the public optioned he would go to his campaign website to support the public optioned within what is fact show and what is not. >> maybe we need a lie-detector no politicians should be allowed to speak. [laughter] >> whenever it is some kind of innovation is essential because you can really have a functioning democracy when it has been destroyed and that is the case i know when it comes to the media we are abscess with fact checking and despite the fact we have citizens hundred the bloggers you cannot do

without editors and gay people to make sure that you can turn your readers trust. >> are you the optimist about technology and the media? i think many people worry what happens means we don't give investigative journalism anymore to the extent they are not challenge by realities which reinforces the worry about that? >> first of all, i am greek and this is the optimistic nation with a double dose but i think i am optimistic about technology provided we can disconnect that is another thing i'd like us to create a defied that when we

are no longer aligned. we are so high for connected we don't spend enough time being connected with our own intuition and a sense of the truth and we need that. even at this lehman brothers somebody was disconnecting there was nobody and i think we need more and more of these leaders agreed is quality is to see the iceberg before it hits the titanic but to do that you have to be connected with your fans to be able to see beyond i have an entire

section on levying so for example, i committed to get some money hours her night and i applaud them all. i have seen how effective i am. [laughter] make sure you go to bed early tonight and dinner and sun time as seriously as much as something that is a minor matter it is ever on sense of finding a solution. that is number one. with technology in being able to disconnect the other is that in order to sustain we need to find a friend models we've for example, have eight not-for-profit and for-profit model via

bolsa raised money from foundations because investigative journalist report we don't have instant results and one more thing leading up to the meltdown so in order to maintain access many pull the punches and and we often can do a better job without reporting on what is happening. >> we have the professional

and ethical supply chains questioning how having a direct personal relationship struggling with africa or india is essentially my kimmie-- co-workers.com you'd have people all over how does that change of how i relate to doing a very different job or living a sort of a different life with financial trade and outsourcing? clearly i imagine it would develop as people are finding ways to seek each other out and communicate. >> i love that.

that is key. we need that. founding the foundation they have said teaching empathy and children will be an increasingly critical because they cannot imagine a healthy world without and that. and also, again, something in the guidelines that encourages us. a reality show nobody expected to see an undercover boss. i don't know if you have heard about that but it is a sensation. these people plan on a disguise and work among the lowliest and they see how they work and their hard chips and what they go through and obviously it is a microcosm of what is happening across the country

all of of the fact that for decades now we have had the top 1% extremely well and the bottom 20 percent. >> there is the sense that has been reinforced by now they seem so remote to and divorced. i can see why this show does. we will take questions now. >> please say who you are in the company you are wes. >> robert tucker from innovation resources and my question is you are not a gadget that now you read that book but jason talks

about the creative destruction force of the internet going back over 15 years how it is caused so much so my question is, as you are the leader of the "huffington post" how do you look at that? the being in the work taxed at we're supposed to be creating new opportunities but the music industry has done just the opposite. >> so you are in favor of creative destruction. [laughter] >> joking of part there is a

store that has led to what is happening with an incredible loss but -- loss of jobs. it includes what is happening with the consumer habits that people like to go online to go deeper in the link the economy with consumer habits but also has to do with the fact that so many people missed the boat. they fail to see what is coming. it is what is described in the book about disruptive innovation. the combination there are a lot of facts with the near financial meltdown and advertising went down. but right now a lot of mainstream media is doing a

good job and doing really good things online. with the distinction with the online media and it was not significant because it will be both. then "new york times" does it along those lines and we are increasingly hiring reporters and breaking stories and moving into what has been them and of tradition. i rather have a future than a two separate world. >> >> hello. i was just wondering why shouldn't america become a third world country may be that would increase our

embassy? [laughter] >> we obviously want to make sure we don't become a third world country because one of the main problems would be the distraction of the middle class which has been the foundation of america also the foundation of that american feeling. americans do not begrudge because they aspire to be rich and they believe they will be rich or confident they will be. when downward mobility is the new reality you finally live in a different country where there is a no phobia, a anger at success, a fear, that is not a good healthy way to live and increasingly there are solutions to a big problem

and that is renovation is because we can afford to have financial reform like the one restarted to shepherd through out the senate. anise basically these will fade in the medium term and that is the reason so that we cannot imagine what may happen imagine the worst in order to prevent it. remember how often after something tragic happens with the destruction of a new word veins or 9/11 or the financial meltdown one of the things that people often say who could have thought that? a city like new ordains been destroyed who could have imagined planes flying into the twin towers?

in fact, there have been a lot of predictions about all of that but ignored it. >> we need a marshall plan or manhattan project or something like that. >> we need to things we need something at the national level back at the manhattan project does something at the local level. it is kind of from the top we are the awakening of our own embassy in recognition be have to do something for the people around us for our own communities. it has to be a twofold response not coming from the top. >> a short comment and a question.

there are several countries i can tell you a katrina, it never would have happened. empathy is better. my question is why are you putting this subject? will of america what is behind the question? >> we like provocative questions. the reason for the title is obviously a first of all, because nobody is arguing that it is right now part of the reason for picking a

title that is provocative to have then pay attention it is like sounding the alarm bell that there is something going on that we're not paying sufficient attention. there was a study that shows unemployment among the people making 150,000 or more is only 3 percent and unemployment among those in the bottom 10% is 31%. if this higher at the top then you would be hearing about it all the time on television, radio, everywhere i am trying to have a national conversation because we have a window right now where we can respond.

after a certain period of time the window closes. cassandra. remember cassandra? she was right. especially in this country we don't like cassandra because we want to see that everything is fine. don't worry, be happy. better now than two lays fact that is an interesting reaction. to challenge people in that way such a desire and also in washington this was the absolutely catastrophic moment to get back to normal that it really did not all happen. how do you break up the public? you have the sense of how you can wake of public up to get them to take the issue seriously? >> but rite aid of the short

but of euphoria it is the point* you are making. not just now but throughout history people it to very quickly that they are paying out and we need to make sure we don't fool ourselves into thinking the different a. what i am advocating in my book and did your book why it is not some conversation. >> i could carry on talking to you with more questions but unfortunately we are on a very tight schedule.

>> you may e-mail me at arianna huffington.com. thank you very much. [applause] . .

sam and his 27 years in the chamber and his unsuccessful run

for the presidency in 1996. this event hosted by the dole institute at the university of kansas is one hour and ten minutes. >> good evening. i'm the director for programming here. we are spending our 2010 presidential series examining of a congressional career of bald dole which began half a century ago. last week we heard from biographer jay thompson who give a overview of senator dole's life and time to read tonight we are going to focus more on the concrete legislative achievement. something many of us have come to tell you more and more after watching them hundred tenth congress struggled to complete the fixes the cell to do. my hope is by discussing legislative daring do constructive bipartisan deal making, poletti and leadership here in kansas it will have some effect in today's washington, d.c.. jack thompson and many people who attended last week's program talked of a dole legislative and

leadership style that puts a premium on getting the right number of senators on board getting each members to give as much as they could while remaining true to their constituents and their beliefs. this i would argue is how you got legislation like the americans with disabilities act or food stamps. the fruit that crossed the alliance with senator george mcgovern with a 1983 social security fix or tefra, the tax equity fiscal responsibility act. granted the numbers game was different back then you will need 51 votes to get things done, not the defacto 60 today to be back a threatened filibuster. dole's leadership relied on a senate rule and of the personal political touch that made him a legend in the body but it also relied on detail oriented and encyclopedic knowledge of the issue at hand. anyone who knows senator dole and was he still has a terrific mind for policy detail. in fact, even that is not enough. you need help.

you need staff. and dole is known for having the best staffers and the legislative branch and holding them to a very high standard. to help analyze the significant legislation of the dole era in congress we invited several staffers to give us the inside story of how senator dole lead. before i formally introduced tonight's panel would like to mike ditka recognize others to lie to work on the senator's legislative and campaign staff. i won't make you stand in and there is yourselves, what i see in the audience mike murray, david owen, scott richardson, leah richardson, scott morgan, john peterson, john bush, allyson carter, judy krueger and ellison krueger. thank you for the service. on the panel tonight, starting in the middle, sheila burke with the chief of staff from 99801996. prior to working for the senator she had been a staff member of the committee of finance, 1979 to '82 and deputy staff director

of the committee from 1982 to 1985. she was the first woman to hold the chief of staff for a majority leader. at that time, she was often as the 101st senator in recognition of the latitude given her in running the day-to-day operation of the senate. a native of san francisco, ca durham a master's from harvard university and bachelor of science in nursing from the university of san francisco. as a durham fight health care practitioner, burke had deep wells of knowledge and authority on issues of health care reform. from 1996 to 2000 she served as its szigeti an elector of public policy at the school of government and from 2004 to the dozens of and was a secretary and chief operating officer of the planets greatest constellation of museums the smithsonian institution. she's currently at john fletcher and public policy at harvard kennedy school of government. wo 1986 and spent time at the chief of staff in '85 and '86. his specialty in finance and issues led him to positions on

the u.s. senate committee on finance and he served as deputy secretary of labor in the george h. w. bush administration. he's currently a partner of the influential law firm covington burleigh. he also came up with the acronym tefra for which many people are still angry at him. [laughter] rolph friend served senator tefra and a staggering number of roles that men graduation of tebeau in 1986 and in 2000. those include in terms, senior adviser and body man in his last capacity handled the logistics every single one of them both in the senate and during the election campaigns. as we know from his visit last year might serve as the director of vice presidential operations for the mccain palin 2008 presidential campaign. a position that has enriched the lifetime of stories. [laughter] he's a president at llc international public relations communications corporation. please help me welcome sheila c. bair, rob dearment to the

institute. >> things to all three of you for coming tonight. it's special to talk about senator tefra and his accomplishments as an individual. i would like to begin by asking each of you to tell how you came about working per for bob dole in the various roles you have in his office. let's start with you. >> i came to work for senator dole in '79 when the senator goes to the position of ranking member of the senate finance committee replacing paul curtis and dole as elevated and i think the senator wanted to give some young warriors to help staff that committee and through elizabeth elizabeth called one of her classmates at cal for ten and birling and the bald and myself worked at covington and

birling and i think that bob recommended us and came over as the republican staff director and i came over as the deputy director. i think bob was particularly a litigator was interested in having somebody there who understood the tax law so that is one of the areas that i practice in. >> what else did you go on to be so? kind of walk us through also chief of staff, right? >> i was a deputy staff character of finance then i became the chief counsel of staff director of the finance committee and then went senator was elected the majority leader became his first chief of staff followed by the deputy and sheila pushed me out. [laughter] >> i tried with a break. >> that was your story, sheila. >> i actually have to admit i was working in new york city at

the time and as a nurse and had come to and from washington to help the nursing issues and had gotten to know from the finance committee and senator dole decided because he at that time was the ranking republican on the subcommittee and finance and he was relatively junior member of the committee that was along with herman talmadge the chairman of the subcommittee decided that he was interested in having somebody on the staff who had taken care of patients. there was a physician who worked for senator long and sadr talmadge who was terrific and a good friend to this day and ran the medical center in kansas, kansas city for a long time and senator dole decided he wanted someone who would actually care for patients and had some understanding of the health care delivery system and so i was recommended by the finance committee staff to interview senator dole who i did not know having been born and raised in california and san francisco

jury liberal democratic parents and we interviewed -- this is sort of interesting but not what i expected in terms of a career choice and i said to the center during the course of that interview in his office in the dirksen building i will never forget you know, senator, i actually a democrat and from california we have a long history sort of the other side of the line and is coming to me at the time which remained true in the 20 years i worked for him and said i don't care what your politics are. what i care about is what you care about health care and i want someone who knows and understands that issue so i went to work from him as the but as lead of staff of the personal stuff and when he began drinking on the finance committee when he was asked to join the red committee staff by got it wrong to be essentially handle health care issues and then became a

deputy state director in and responsible for all of the programs on the finance committee and became chief of staff and the majority leader's office and ultimately chief of staff re-ride remained with him until the u.s. senate. >> you had your conversion to republic. [laughter] >> in the midst of another sort of side note in the midst of it, i decided to go back to graduate school and had been accepted at harvard and announced that i was departing the finance committee to go back to harvard and again and harvard essentially in the fall of 1980 and of course the samet dee dee kucinich flat and we took a majority and was asked to come back to the finance committee, and at the time, michael dukakis was my adviser at harvard and i went to mike and said i have this opportunity for finance.

senator dole being the chairman i'm not sure what to do should i finish my degree? and might help me work out a scenario whereby flow to harvard and finish my master's degree for the finance committee full-time. >> the governor was here about three years ago. >> i grew up in rural kansas so i from a young age i have been quite familiar with senator dole as a political figure in kansas. as a matter of fact 1974 in the senate race i was on the bumper stickers quote in kansas said that was my first -- [laughter] -- moment with senator dole. i later went to the levers of kansas 1985i had the opportunity to get a -- to get an internship in senator dole's office so that was the start of my official capacity. in 1986i went to washington and was able to work for the balance

of 85i worked as a volunteer in the campaign office and washington and january of '86 i was offered a position as the junior staffer on what was then his finance fund-raising staffer from 1986 reelection campaign and alexandria va. swain march -- and i took the job having no other alternative. [laughter] in march of that year, senator dole having been elected majority leader the prior year spend a lot of his weekend campaigning for others. and so there was this need by identified for someone who was available on weekends, would work seven days a week. i think i added the advantage of being a fellow candidate so i was asked to go on the campaign trail with senator dole and went

to michigan with him in 1986 we immediately hit it off and had a good personal relationship and i proceeded to travel with him around the united states and abroad for the next 15 years, during that period i had a number of roles all with one exception all of which were four of his campaign committees. i worked as his personal eight or has jonathan referred to the body man or body boy in his '88 presidential campaign. [laughter] and 89i came back to kansas and managed his senate field offices. in 1992i managed his final reelection campaign to the samet and following that i helped manage his national political action committee. i was still living here in kansas. my presumption prior to the '94 campaign is that was sort of the end of the road.

it didn't seem there were going to be further campaigns either here in kansas or nationally which wasn't apparent to me or anyone else up the time. but upon the electoral landslide of 94 republicans took back control of the house and the senate and shortly became apparent senator dole was going to be a significant and ultimately successful candidate for the republican nomination for president so i went back to washington in mid 95 through the '96 campaign and had a not dissimilar will to 88 -- that i had an agent also had a much broader responsibility primarily for the operations logistics of the campaign. so following the '96 campaign, i moved shortly after the '96 campaign to new york and continued working in a consulting capacity with senator

dole through 2000 on a variety of undertakings and remained trend today. >> i'm going to start with you on this one and this is a tough one because we all would have so many. but if you had to recount one or two of your favorite bob dole story is what would they be? humor is, whether they show his leadership style, his character, what would be the one or two stories that he would share with us tonight? >> probably the humorous story would be the morning of january the seventh of 1988. the phone rang at home and it was not unusual for senator dole to call any of us at home at any point in time. >> or any hour. >> or wherever he happened to be triggered and at this point, he happened to be in iowa. it was 1988. the phone rang about 7:00 in the morning at my home and my father

answered the phone and senator dole never identified himself. it was always hello? we knew immediately what was. the low? sheila? and my father said sorry she's gone to the hospital, she's and labor. i was expecting my first child at that time. and there was this did pause my father described at which point the senator said well when will she be back? [laughter] and, you know, i and all three of my children i had when i worked for sadr dole of three happened to be born during congressional recess. and senter dole never understood why any of our staff ever had children when we were in session. he would always say she let them during a recess. [laughter] but on a more serious note, during the five budget impact during the period of time of the

clinton administration, the government had been shut down for a period of time and we have been going back and forth with house in terms of continuing resolutions in an attempt to try to get the government back operating and to pass a sufficient amount of money for a pergola of time that allows the government operate and the house was determined to be essentially force the issue, and mr. gingrich, the speaker at the time, and dick armey and others were opposed to doing anything to allow the government to go forward and wanted to sort of force the issue. there was a point in time we were bouncing something back-and-forth and the house once again indicated that they would be unwilling to pass something in the senator dole can out of the cloakroom and said to me you call dick armey on the phone and tell him the next time we are not going to stop it. these people have no idea what

it's like to live from paycheck to paycheck, and they are essentially doing enormous damage to the people in this country who we depend on. and it was an indication of the things that at -- when it really counted what he cared about, and it was -- he had extraordinary respect for the public service nature of government and the people who perform those services and little tolerance for the sort of indifference that seemed to be being shown and the kind of brinksmanship where other people's lives were at risk and of course i had the opportunity to call dick armey and pass along this message. [laughter] i wasn't quite as effective as senator dole would have been. but nonetheless, it is a memory i will long hold and again, it gives you an indication of the kind of man he is. >> i was thinking of a more humorous. he used numerous as a very effective weapon, and a lot of it was self-deprecating, but i

remember one particular markup that we had and senator dole was a great fan of the use of ethanol, and we had a proposal to to enhance the tax benefits for ethanol, and i was down in the witness chair has the staff director of explaining to the committee what senator dole's proposal was and in the course of a marked and then the senators would be free to amend it and then they would vote on it, and so i am describing the proposal and senator bradley, who was at that point a vigorous opponent of the gasahol tax incentives and was tortured me with questions, how does this work, what does this work, what is the level, how much is the subsidy; and i just getting

sliced up by senator bradley and senator dole is just sitting there. [laughter] and finally, senator bradley said mr. dearment, what is this proposal cost? and at that moment, senator dole broken and set senator about me, it costs just about as much as the mass transit provision that you are interested in. [laughter] and senator bradley said now it is all coming into perspective. [laughter] senator bradley had occasion to run for president and had a conversion in iowa to see the beauty of ethanol. [laughter] >> mike? >> i think my story is not particularly specific but more to the general character of the man. it goes to what sheila was referring to about his ability

to communicate with working people in particular. so i think one end and hinchey had over his colleagues in the senate from my perspective is like many of them who on the weekends i don't know what they were doing. i know what she was doing was attending hundreds of town hall meetings and, you know, states all across the u.s., in particular in iowa, kansas, new hampshire. but i think through those meetings, he had access to -- far greater access to real people and engaged in dialogue with them to a far greater extent than his colleagues did which in turn from his ability to communicate to their need and legislation when he went back to washington, so i think there was a particular strength he had that was a significant advantage. as an extent of that my experience was traveling with him and campaigning was that again i think on like a lot of

powerful politicians in the positions he was and she really didn't differentiate between the billionaires' and the billow washers in my experience. as a matter of fact, she more identified with the washers and in every case when we were in a particular location he would make a point of going to the kitchen and going behind the back of the house to meet the people -- the working people. so again, i think that urge and instinct for him to engage with the common man was one of his greatest strengths when it came to translating that into the legislation policy. >> doesn't the senate elevator operators of a stick and and you will vote on who was the most popular senator in regard to the elevator? >> he won that poll. >> it was interesting when he made the decision to leave the senate he made an opportunity for folks to come and say

goodbye. little did we know at the time, he essentially within the that occurring was day after day after day he would stand outside of what was known as the dole beach, which was essentially a patio that overlooked the mall outside of our offices. he would stand there waiting for people who recently lined up for hours, all the operators, all of the guards, the cleaning staff, all of the runners to essentially get their photograph taken with him. and he would stand there. and it was -- even today when you go up, when i go out and i sure this is true for rod, when any of us are in the senate there is an immediate acknowledgment of having been a dole staff person and a fondness with which he is held by the folks who work the bad calls in the senate is an indication that he never, never hesitated to

stop, never hesitated to ask someone how they were coming to them by name. you'd have gorbachev or someone in the office or some poor cleaning woman would come in martha, have you met, you know, gorbachev, some poor leader standing there thinking what is this man doing. [laughter] but that is exactly right, he was beloved and that is because he eventually they were. he would never walk past them and he essentially click your fingers waiting for them to open your door. he was remarkable. >> i was going to ask this but that sets up this question perfectly. talk a little bit -- you were there with an -- talk about that last day in the senate. the decision to leave to devote full-time to the campaign, kind of your thoughts on that, and then i would like to ask what counsel they gave to him on that issue because i know there was a really difficult decision. >> it was.

and his decision to do it and then the date that we announced it was somewhat separate. but it was clear and remarkably difficult decision for him to make, and it was one that i think that he made recognizing that it was going to become increasingly difficult to manage the business of the senate. it was something we will get into in terms of his remarkable skills on the senate floor and in legislating. and that is at odds with running for anything full-time and i think that he acknowledged it would be unfair to his constituents in the sense of his own caucus as well as to the body to try to do both and to perhaps neither well. he made the decision and he made the announcement over in the senate office building and the word had gotten out and the number of democrats who attended and who spoke to him and of course his last actual day in

the senate was remarkable. the chamber was completely full. there wasn't an empty seat. and the number of members who came up to him who acknowledged how remarkable he had been as a member of the body where they fought over issues. but the respect with which they held him was just palpable in the chamber, but it was a tough decision but i think that he felt it was the right one for the body as much as anything else and i think again it shows the respect he holds the institution and how we important that relationship was for him. and again, whether it was danny inouye for whom he shared a hospital when debose came home from world war ii, his long history with pat moynihan and george mcgovern and george mitchell, robert byrd, you know, tom harkin and the work they had done, ted kennedy on voting rights. there was a -- on the other side of the aisle as well as his own

colleagues i think an acknowledgment of change that would occur with his departure. >> like, what did you feel that they? >> for me, it was more of a -- it was shocked. in particular i felt it more as a kansan and was a palpable sense of loss for the state because i knew -- i had learned enough by then to know that the leverage and the power seniority that sadr -- senator dole brought to our state was so significant and would never be replicated so from that perspective it was as a campaign operative i frankly was heavy on

one hand because i knew it would be easier to concentrate and focus on the general election we were facing which was an uphill bell to start with. but somebody from home i felt a sense of loss of representation that he had built up for the state over the years. one other thing i want to add about that that's not about how i felt that day but in retrospect, it struck me the example that he set a fleeting not only the majority leader of leaving the senate as the party nominee was a particularly graceful way to exit his congressional career. i know that more recent examples of kerry and mccain, their decisions to go back to the senator frankly less than grateful and presented a posted all court mess that having

reached the pinnacle and being back on the legislative process that i think senator dole recently avoided -- graciously avoided much to his credit. is the negative you have anything to add? >> i remember that day vividly. it was a day of sadness because i thought and still think of it as the passing of an era. there was no other majority leader quite like him or hasn't been since. some great majority leader's post well before and after. he gave a moving speech. it was -- there wasn't a try i in the room. it was packed to the top of the hart building, this great big cavern and everybody was moved. >> and it was true on the floor as well. again, both speeches, but his

last speech in the united states senate as well as the speech acknowledging that he had made the decision to leave or both. remarkably graceful in his acknowledgment of the institution and the people with whom he had worked. >> let's talk about his leadership style. i never worked for him on the hill but i was on the hill in various roles from the campaigns seeing how he did things and one of the most amazing things that i ever saw is how he would have a majority leader will topple meetings and would basically go around. rod, she land lie, tell about that. >> he was a master of meetings, and i will tell you a remarkable set of meetings that was a courageous effort that didn't result in legislation and that was an effort to seriously tackle or budget or cut spending

in 1985 and he went after that. he assembled groups of members sort of small groups, large groups. i think we finally counted when we were done the best we could and we have like 43 meetings of various members that he would pull together and we would -- dave stockman was i think part of that effort from the omb looking at different ways to trim the budget programs that have long since outlived their usefulness. we would have ended and we got that together. we voted out of the senate and the house and didn't and of taking it and a lot of the programs that were long live out

are in place today so there is probably some we could go back and negative, but that was a force of massaging the list and putting it together and it's really the dynamic of his personality is never say diet energy that he would keep pushing and somebody would say i can't have that. there were flashes i remember a very heated discussion between low and david stockman that made every other member will get their shoes. it was so embarrassing that particular thing that he pushed ahead, put together a package and got the package enacted out of the senate and into the house >> rot is right.

they were never happy then when there were multiple meetings going on and they would have meetings taking place in his conference room and his personal office and a meeting taking place back in rod's my predecessor. and he would move between the meetings and encourage people to stay. but he was also quite adept at the essentially going outside the box and whether it was the passage of notes between moynihan that brought the rescue of social security, whether it was the conversations with tom harkin that brought the disabilities act he was capable of going outside of the boundaries of his own party and his own caucus and to cross the our leal and the essentially work the deal. the catastrophic health insurance bill essentially he and senator mitchell found themselves together to try to

move forward believing that infected was going to be in the country's interest to do those kind of things. but it was persuasion, it was an extraordinary knowledge. he never ceased to amaze us with minutia we would have forgotten and he would have dug up from some place that he knew a particular member needed something and he was differential where he needed to be and quite firm where he needed to be and rarely ever did he essentially give up. so you didn't leave the room. he would come in and out of the meetings and something horrific, someone would be arguing and he would make a comment about well i see we are making progress. she knew just when to bring humor into the room when things were getting difficult and when he essentially to let people go. mark hatfield for its sample the senator from oregon had a

longstanding and firm point of view on issues around the death penalty and on a variety of vietnam, there were a number of things he felt very strongly and he would know the line you couldn't cross. he knew there were members who had used essentially were firmly held and that you couldn't push and he knew when to stop but he also had extraordinary patience and he would wait people out. rod and on the way out i was remembering an instance where we had been in the session quietly and dole was trying to work out a consent agreement with senator byrd. senator dole was the majority leader and senator byrd was the minority and senator dole gave him the agreement that would have allowed us to proceed on a piece of legislation agreeing to a set of rules that would allow to essentially ordered the amendment and so forth and senator byrd who is a very

formal person and it felt strongly about the personal relationships to coffee agreement from senator dole and went into his office and began to play his fiddle and we could hear him play the fiddle and of course we are all tied reading about trying to get out and senator dole simply sat and i think that senator byrd finally came back with about 2:00 or 3:00 in the morning. but we've essentially just sat there and senator dole just wait him out and knew he needed whatever time he needed and essentially the pressure of time needed to move things forward but it was a time to wait. there were times he wasn't as patient but he was remarkable in sort of his sins of that. >> how was he so successful at getting senate terse consistently when he was leader either minority or majority leader to take votes that maybe they would have preferred not to make? >> i think it was personal persuasion that he would talk to

people and sort of waiting people out, i remember the last day of one session when he was the finance committee chair and going with him and sitting on the senate floor we had a number of bills come up for one reason or another. there was an amendment a person wanted to have that they had to have and we had maybe a dozen bills and he started with a bill number one and would get people on the phone and try to work out their problems and compromises would work and he would work in that bill until we either got it free and passed for it was so hot that he would move to the next one and we did that all day long and into the night we kept working down he would be calling people trying to -- listening to what they had to say, knowing what he needed to have, trying to find where the magic formula

and he was very clever. he would try different things. how about this, and he had a great sense of compromise to be found and managed to find them. >> i think something people were -- there was some discussion of tefra, my favorite bill that i named. i don't know who doesn't like that name. [laughter] also my longtime mentor for whom i started practicing the tax with a professor edwin cohen at the university virginia law school, a great lawyer always told me we mispronounce it. it should have been called tee-fra so we could have tee-fra

two. [laughter] but tefra was a remarkable performance by bob dole to deal with the problem that we find insurmountable now which is dealing with the deficit also at that time we had a huge deficit and we had very high interest rates in the order of 18% interest rates and dole and some other members of the finance committee met with paul volcker, the fed chairman of the time and he said if you pass a package that cuts the deficit by a specified amount, he would ease off on the interest rates and so that was the motive they had and the members of the finance committee in particular the republicans took upon that as a challenge, and we put together

in 1982 -- tefra was mainly the tax piece there was a spending company called the three legged stool, the famous often talked about the three legged stool, and it was tax increases, spending cuts and interest savings which did get enacted and paul volcker did cut the interest rates and that put the back on the high interest rates that had remarkable pay off for the country. terrific cost and was a political exercise while he compromised with people. on that he put together tefra and that package with a single democratic vote in the senate. chairman past it without a republican vote so it was the

democrats that supported the house and republicans in the senate up as though it was a remarkably bipartisan bicameral way because both chairman realized the had the responsibility of doing something and it was i tefra said the votes but they did it. >> can i add something from my perspective with think it's important to remember by the time he had been elected majority leader he'd been on the national stage and at the political way for 25 years. so my experience of seeing him with the senators and members outside of washington was that he had an encyclopedic in seemingly in-depth knowledge of their position in the districts and states he probably knew well he definitely knew when they were coming up for reelection and he knew, he probably knew the percentage of the votes they

had gotten in the past election and probably how much money they had for the next election. so i think all of those factors in the way he was able to bifurcate his role as a politician and legislator i feel all that data, too, was brought to bear in his negotiations in the senate with members and how to get their votes and who wouldn't be with them and who would and that made a significant advantage in the majority's that she won and rot are referring to. >> very good point. that kind of sets of talking about tefra, a couple of his other accomplishments he's very proud of, let's talk about a couple of other things. americans with disabilities act was committed to americans with disabilities to read its entire career was one of the first speech as. >> the first on the floor was bill disability. exactly. standing interest. one of the remarkable things

senator dole described when he was in a crowd it always amazed me he would instinctively go towards people who had some obvious disability if he were in a room if it was someone in a wheelchair if it was someone in any way impaired he was drawn to those people. it was obviously something he felt strongly about. it was obviously not something high on the list of a number of republicans but he had a keen appreciation i think for what he believed to be the appropriate and important role the government can play in helping people help themselves and whether it was the provisions that we also dealt with should the medicaid program to allow people to a essentially keep their coverage when they went back to work so that there was no disincentive to work because suddenly you lost your health coverage. those kind of accommodations again recognizing that people

need a helping hand up in order to help themselves and i think that he approached that with harkin and others as an acknowledgement that there was a population that needed remarkable consideration. the same is true of the food stamp program and the work he did with george mcgovern decision by recognizing the extraordinary meeting of the role the government can play in a responsible way to help people help themselves so i think both of those are evidence to the abilities across the aisle and stopped at this time but his acknowledgement of the balancing act for inappropriate important role for government in the right way. >> one of the other great accomplishments that he remains to this day very proud to discuss salvaging social security. >> i often hear today the notion we need to put together a

commission like greenspan commission the assault social security but the greenspan commission was about to put out a report that made no recommendation because they couldn't solve the problem and senator dole was a member of that commission as was senator daniel patrick moynihan from new york and senator moynihan loved the social security program. he was devoted to it and he and senator dole got to get free and senator moynihan said we can't let this go like this. that is the commission just put out a set of options with no recommendation. and so the two of them started a dialogue and then they got dave stockman involved in the dialog to try to hash out a proposal that the pri but they could agree on where everybody gave on increasing and accelerating the scheduled tax increases and to

tax half of the benefits and the benefit cuts and greater coverage and then they sort of got the gang of nine and build more consensus around the but it really started with the conviction of senator dole and senator moynihan and putting that together that sort of lifeline to -- lifelong bond they had, and the added remarkable relationship. i remember a couple of years later going on a congressional delegation through asia which was a -- another -- >> it became known as the bataan death march. [laughter] >> there was a lot of work. we brought one democrat with us and -- moynihan.

but i was a singular achievement , that rescued social security we were at a point where it was about to go under and we needed to have a next generation of senator dole's and senator moynihan's to deal with the train wreck that's not too far away. >> i was just going to say there are those remarkable three large pieces of legislation. when an enormous amount of medicare medicare debate connecticut policy allows children that occurred during the 80's and 90's with a result of senator dole and henry waxman and interestingly enough that in addition to those big remarkable things we know of there are the small face. we had a young man on our staff who was an intern in kansas as a matter of fact, and a young

college student and he was had hemophilia and he can to work for us as a summer and having been on average that he had the opportunity to meet the senator and having talked with us about the sort of challenges he faced and the family faced. one of them was a small issue we tried to whether or not when you needed a clotting factor and of course they don't have the clotting factor and so they tend to lead the drug you can in fact used to help the clotting factor but at the time medicare would only pay for it if he were eventually going into a hospital to have the service provided. or it was something that could be easily and administered at home and would be much more reasonable for a young man at his age to be able to deal with this issue. a direct result of that young man with the passage of a provision to provide this of

administration the creation of the hospice benefit was a direct result of dole. the creation of the rural health care clinics in the locations around the country and medicare acknowledgement of the services and the sort of challenges like small rural hospitals was a direct result of bob dole to read while we have the social security tefra, cobra, the whole series of those, there are also these other things for which he gets little credit about which he is directly responsible and had an enormous impact on people's lives across this country. they are really something. is that i was just going to comment on the dole and lenihan relationship. i can recall during a primary campaign of 1988 presidential campaign senator moynihan asked

senator dole his image in one of his campaign commercials in new york which he did which i thought was remarkable this display of bipartisanship, it sort of illustrate their the importance of the relationship. >> that relationship repeated itself in a situation similar to the social security situation of the didn't play out as well. the social security event occurred because the conversation on the floor between moynihan and bob dole. during the debate over health care reform in 1994 through that period of the reform from '93 to '94 a similar conversation occurred and a note passed between lenihan and dole singing isn't it time for us to step in and make this work. and a whole set of circumstances prevented that from occurring not the least of which was the antipathy between moynihan and the clinton administration. but the upper tennessee was

there for the moment where we might have been able to get something done. >> we are going to open up to questions in just a moment after i ask one more. so if you have a question we have to students who will have cordless mics. raise your hand and we will give you a chance to ask your question. but my question really for all three of you. how is the senator of bob dole and ted kennedy and robert byrd and 25, 30 years ago they've been talking about, how is that so effective and how is it different from the senate we see today? >> well, some of the activities we engaged in in the senate there were long debates. i don't think we have in the debates in consideration today quite like the had then. maybe they don't have the same

work ethic like they did then but the windfall profit tax debate in late 79 early 1980 was on the floor for months. i don't know that we debate bills for months today. some people had an opportunity to offer their amendments many times over. there was perhaps the creature collegiality between the members even though there was very partisan votes and partisan activities. as i said, the tefra was created in the senate, passed in the senate entirely by republicans and so there were no democrats

that chose to join in that particular bill. there were others that were much more bipartisan. so i think it might be the sort of tradition of long friendships members served them and worked together along party lines so even when there was party-line votes they still could be civil with one another. >> i think we are all struggling to understand why things have become so partisan. much more obviously than they were in the period of time that we served in the senate. that isn't to suggest there were not battles that occurred because there were quite pitched at times. and clearly there were partisan. senator dole could be very

partisan but also knew when he essentially to reach across the aisle. i think there was a sense of the importance of legislating to a conclusion that there was i can remember senator dole on more than one occasion commenting that he really thought it was a win to lose. that simply putting something that to force people to vote knowing it was landaluze that put people in a corner rarely serve anyone's purpose. but the purpose of legislating and in fact he was criticized at times as a candidate of being too legislative and talking in legislative speak and talking of some religious leader and in fact he was and i think there is less sense of that now, there is a sense of blocking people into a corner and forcing them to take positions at odds with where they needed to be, less risk taking. many of the members search together a very long period of

time. there were some who suggested there's a greater presence house members in the senate now and there's a desire for the senate to operate more like the house. the senate is a messy place, very controlled environment where the majority has absolute iran control the senate isn't a body that functions that we historically. it is a body that largely does its business by consensus. most of the work we were involved with rare exception was done by consent where the leaders will eventually agree that what the structure was going to be or what you're going to get done and the rules which were able to get it done at the end of the day you easily work to try to come to closure. there is less sense of that now whether it is the nature of the individuals and the body and the sort of history with some of them. i can think of the members on the finance committee when rod and i first went on the stuff and they were people like a big

and russell long and herman talmadge and john chafee, just sort of people that had long histories with the institution. is that the difference today? i don't honestly know the answer but i think that we are all struggling to try to figure that out. >> what's open up to your questions and answers. if we have a question of who would raise your hand. i know somebody here has a question tonight. >> we can get a microphone over here. >> i will threaten everyone. i have plenty of other questions. this is your time. >> i understand that senator dole and tom daschle [inaudible] >> interestingly enough, president obama has now three or four times over the last couple of weeks referenced the proposal

that dole and daschle and howard baker and george mitchell put together. we started working on it over a year ago and we've really -- released eight last june. it has the support of all four of them although mitchell but it's supported by mitchell but then by daschle, dole and baker. it has elements that are common to the house and the senate and are both democrat and republican. they sort of came to the table and put everything on the table. senator negative all agreed to the limitation on the tax treatment of health insurance benefits. he agreed to a number of other provisions. no public plans. he agreed to allow interest to be purchased across state lines. senator dole and baker agreed to allow all individuals to have coverage but no mandates on

business. they agreed to a number of preventive services and they agreed to a variety of things that is essentially froze all of them to the opposite points of view but the essentially was a package that would have made major improvements. they did all the insurance reforms, guarantee issue, no pre-existing conditions, extension of medicaid, limited some changes to the medicare program both expansions as well as constraints. obama has referred to a number of times. they've met with people on the house and senate. there is some suggestion and my guess is the three of them they do another op-ed piece before the summit occurs on the 20th of february sort of suggesting that everybody stand down, stand back and come back together open-minded to changes whether it is malpractice reform or whatever it happens to